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We review the results of a handful of the most influential studies that demonstrate the efficacy of exposure therapy and disseminate information about the theoretical mechanisms, practical applications, and empirical support for this treatment.In addition, we provide practical guidelines for clinicians who wish to use exposure-based therapies and empirical evidence to guide their decision making.

Exposures to external cues include a spider-phobic patient handling a spider, or a height-phobic patient systematically approaching increasing heights in a skyscraper.Theoretical mechanisms of exposure therapy Biologically, the extinction of fear appears to be mediated by N-methyl-d-aspartate receptor activity in the basolateral amygdala, a finding that has led to the use of neuroplasticity compounds such as d-cycloserine to augment exposure.For example, initial exposure to ocean water can be cold.In imaginal exposure, the patient is asked to vividly imagine and describe the feared stimulus (in this case, a traumatic memory), usually using present-tense language and including details about external (eg, sights, sounds, smells) and internal (eg, thoughts, emotions) cues.In recent years, virtual reality exposure therapy (patients are immersed in a virtual world that allows them to confront their fears) has been examined as an alternative means of imaginal exposure, and preliminary data suggest that it can be quite effective.

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